CUSTOM TRIFLANGE ACETABULAR COMPONENTS IN REVISION HIP REPLACEMENT (EXPERIENCE REVIEW)

Abstract

Extensive defects of acetabulum especially accompanied by pelvis discontinuity at the level of acetabulum pose a serious challenge in revision hip replacement and create additional complexity in fixing the acetabular component. One of the perspective options to solve the above issue is the use of custom triflange acetabular components (CTAC) designed based on preoperative computer tomography given the specifics of bone defects of the patient. Purpose of the study — to evaluate the outcomes of CTAC use in revision hip replacement.

Materials and methods. The authors analyzed treatment outcomes of 12 patients after revision hip replacement using additive techniques of computer simulation and 3D printing CTAC. Follow up period after the surgery averaged 7±3 months (from one to ten months). 7 out of 12 patients had acetabular defects of Paprosky 3B type, 4 patients had defects of Paprosky 3A and in one patient — of Paprosky 2C.

Results. Two out of twelve patients had prosthesis dislocations that required revision hip surgery, one of those patients underwent open reduction of dislocation with wound debridement, another patient underwent replacement of articulating couple of acetabular component. Total scores under Harris Hip Score and paint VAS score prior to treatment was 28±7 and 7±1 points respectively, postoperative scores were 76±9 and 3±1 respectively.

Conclusion. The application of additive techniques for revision hip replacement in patients with extensive acetabular and pelvic defects allows to make a precise preoperative planning, to restore joint rotation center, to reconstruct bone defects and to securely fix triflange acetabular component that altogether significantly improve treatment outcomes and patients satisfaction with the surgery.

About the authors

A. A. Korytkin

Privolzhsky Federal Research Medical Centre

Email: fake@neicon.ru

Andrey A. Korytkin — Cand. Sci. (Med), Head of Department of Adult Orthopedics.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155

Russian Federation

D. V. Zakharova

Privolzhsky Federal Research Medical Centre

Email: fake@neicon.ru

Daria V. Zakharova — Graduate Student.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155

Russian Federation

Ya. S. Novikova

Privolzhsky Federal Research Medical Centre

Author for correspondence.
Email: novikova_jana@mail.ru

Yana S. Novikova — Cand. Sci. (Biol), Junior Researcher.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155

Russian Federation

R. O. Gorbatov

Privolzhsky Federal Research Medical Centre

Email: fake@neicon.ru

Roman O. Gorbatov — Head of Laboratory of Additive Technologies.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155 Russian Federation

K. A. Kovaldov

Privolzhsky Federal Research Medical Centre

Email: fake@neicon.ru

Kirill A. Kovaldov — Graduate Student.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155

Russian Federation

Y. M. El Moudni

Privolzhsky Federal Research Medical Centre

Email: fake@neicon.ru

Younes M. El Moudni – resident.

18, Verkhne-Volzhskaya naberezhnaya, Nizhny Novgorod, 603155

Russian Federation

References

  1. Pivec R., Johnson A.J., Mears S.C., Mont M.A. Hip arthroplasty. Lancet. 2012;380(9855):1768-1777. doi: 10.1016/S0140-6736(12)60607-2.
  2. Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Билык С.С., Цыбин А.В., Денисов А.О., Дмитревич Г.Д., Вопиловский П.Н. Применение индивидуальной трехфланцевой конструкции при ревизионном эндопротезировании с нарушением целостности тазового кольца (клинический случай). Травматология и ортопедия России. 2016;79(1):108-116. Tikhilov R.M., Shubnyakov I.I., Kovalenko A.N., Bilyk C.C., Tsybin A.N., Denisov A.O., Dmitrevich G.D., Vopilovsky P.N. [custom triflange implant in revision hip arthroplasty in patient with pelvic discontinuity (case report)]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2016; 79(1):108-116. (in Russian). doi: 10.21823/2311-2905-2016-0-1-108-116.
  3. Кавалерский Г.М., Мурылев В.Ю., Рукин Я.А., Лычагин А.В., Елизаров П.М. Применение индивидуальных вертлужных компонентов при ревизионном эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2016;22(4): 114-121. doi: 10.21823/2311-2905-2016-22-4-114-121. Kavalersky G.M., Murylev V.Y., Rukin Y.A., Lychagin A.V., Elizarov P.M. [Customized acetabular components in revision hip arthroplasty]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2016;22(4):114-121. (in Russian). doi: 10.21823/2311-2905-2016-22-4-114-121.
  4. Della Valle C.J., Berger R.A., Rosenberg A.G., Galante J.O. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res. 2004;420:96-100. doi: 10.1097/00003086-200403000-00013.
  5. Berasi C.C., Berend K.R., Adams J.B., Ruh E.L, Lombardi A.V. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res. 2014;473(2):528-535. doi: 10.1007/s11999-014-3969-z.
  6. Taunton M.J., Fehring T.K., Edwards P., Bernasek T., Holt G.E., Christie M.J. Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res. 2012;470(2):428-434. doi: 10.1007/s11999-011-2126-1.
  7. Pieringer H., Auersperg V., Bohler N. Reconstruction of severe acetabular bone-deficiency: the Burch-Schneider antiprotrusio cage in primary and revision total hip arthroplasty. J Arthroplasty. 2006;21(4):489-496. doi: 10.1016/j.arth.2005.02.016.
  8. Amenabar T., Rahman W.A., Hetaimish B.M., Kuzyk P.R., Safir O.A., Gross A.E. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res. 2016;474(2):408-414. doi: 10.1007/s11999-015-4210-4.
  9. Regis D., Sandri A., Bonetti I., Bortolami O., Bartolozzi P. A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplasty. 2012;27(6):1057-1063. doi: 10.1016/j.arth.2011.11.019.
  10. Ballester Alfaro J.J., Sueiro Fernandez J. Trabecular Metal buttress augment and the Trabecular Metal cupcage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity. Hip Int. 2010;20(7):119-127. doi: 10.5301/hip.2010.5297.
  11. Colen S., Harake R., De Haan J., Mulier M. A modified custom-made triflanged acetabular reconstruction ring (MCTARR) for revision hip arthroplasty with severe acetabular defects. Acta Orthop Belg. 2013;79:71-75.
  12. Barlow B.T., Oi K.K., Lee Y., Carli A.V., Choi D.S., Bostrom M.P. Outcomes of custom flange acetabular components in revision total hip arthroplasty and predictors of failure. J Arthroplasty. 2016;31(5):1057-1064. doi: 10.1016/j.arth.2015.11.016.
  13. Карякин Н.Н., Горбатов Р.О. Технология создания индивидуальных ортопедических стелек с использованием 3D печати. Современные проблемы науки и образования. 2017;(3). Режим доступа: https://scienceeducation.ru/ru/article/view?id=26471. Karyakin N.N., Gorbatov R.O. [Technology of creation of individual 3D printed orthopedic insoles]. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2017;(3). (in Russian). Available аt: https://science-education.ru/ru/article/view?id=26471.
  14. Карякин Н.Н., Горбатов Р.О. Прецизионные персонифицированные направители для эндопротезирования коленного сустава. Современные проблемы науки и образования. 2016;(5). Режим доступа: https://science-education.ru/ru/article/view?id=25134. Karyakin N.N., Gorbatov R.O. [Patient specific instruments for total knee arthroplasty]. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016;(5). (in Russian). Available et: https://science-education.ru/ru/article/view?id=25134.
  15. Paprosky W.G., Perona P.G., Lawrence J.M. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33-44. doi: 10.1016/0883-5403(94)90135-x.
  16. Harris W.H. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51(4): 737-755. doi: 10.2106/00004623-196951040-00012.
  17. Huskisson E.C. Measurement of pain. Lancet. 1974; 304:1127-1131.
  18. D’Antonio J.A., Capello W.N., Borden L.S., Bargar W.L., Bierbaum B.F., Boettcher W.G., Steinberg M.E., Stulberg S.D., Wedge J.H. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126-137. doi: 10.1097/00003086-198906000-00019.
  19. Duncan C.P., Masri B.A. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293-304.
  20. Coventry M.B. Treatment of infections occurring in total hip surgery. Orthop Clin North Am. 1975;6:991-1003. doi: 10.1016/s0140-6736(74)90884-8.
  21. Whiteside L.A. Surgical technique: transfer of the anterior portion of the gluteus maximus muscle for abductor deficiency of the hip. Clin Orthop Relat Res. 2012;470(2):503-510. doi: 10.1007/s11999-011-1975-y.
  22. DeBoer D.K., Christie M.J., Brinson M.F., Morrison J.C. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am. 2007;89:835-840. doi: 10.2106/JBJS.F.00313.
  23. Shon W.Y., Santhanam S.S., Choi J.W. Acetabular reconstruction in total hip arthroplasty. Hip Pelvis. 2016;28(1):1-14. doi: 10.5371/hp.2016.28.1.1.
  24. Ahmad A.Q., Schwarzkopf R. Clinical evaluation and surgical options in acetabular reconstruction: A literature review. J Orthop. 2015;12(2):238-243. doi: 10.1016/j.jor.2015.10.011.

Statistics

Views

Abstract: 697

Cited-by

CrossRef: 9

  1. Korytkin AA, Novikova YS, Morozova EA, Gerasimov SA, Kovaldov KA, moudni Y. Custom Triflange Acetabular Components for Revision Hip Arthroplasty in the Patients with Severe Acetabular Defects: Planning, Surgical Technique, Outcomes. Traumatology and Orthopedics of Russia. 2020;26(2):20. doi: 10.21823/2311-2905-2020-26-2-20-30
  2. Bazlov VA, Mamuladze TZ, Golenkov OI, Efimenko MV, Pronskikh AA, Kharitonov KN, et al. Effects of 3D Imaging on Surgical Tactics in Primary and Revision Hip Arthroplasty. Traumatology and Orthopedics of Russia. 2020;26(2):60. doi: 10.21823/2311-2905-2020-26-2-60-70
  3. Tikhilov RM, Shubnyakov II, Denisov AO. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases). Traumatology and Orthopedics of Russia. 2019;25(1):122. doi: 10.21823/2311-2905-2019-25-1-122-141
  4. Kovalenko AN, Dzhavadov AA, Shubnyakov II, Bilyk SS, Denisov AO, Cherkasov MA, et al. Mid-term Outcomes of Using Custom-Made Implants for Revision Hip Arthroplasty. Traumatology and Orthopedics of Russia. 2019;25(3):37. doi: 10.21823/2311-2905-2019-25-3-37-46
  5. Popov VV, Muller-Kamskii G, Kovalevsky A, Dzhenzhera G, Strokin E, Kolomiets A, et al. Design and 3D-printing of titanium bone implants: brief review of approach and clinical cases. Biomedical Engineering Letters. 2018;8(4):337. doi: 10.1007/s13534-018-0080-5
  6. Kovalenko AN, Tikhilov RM, Shubnykov II, Bilyk SS, Denisov AO, Cherkasov MA, et al. Minimum One-Year Outcomes after Revision Hip Arthroplasty with Custome-Made Implants: Function, Quality of Life and Patients Satisfaction. Traumatology and Orthopedics of Russia. 2019;25(1):21. doi: 10.21823/2311-2905-2019-25-1-21-31
  7. Pavlov VV, Pronskikh AA, Mamyladze TZ, Bazlov VA, Efimenko MV, Zhilenko VY, et al. STAGED SURGICAL RECONSTRUCTION OF MASSIVE PELVIC DEFECT. Traumatology and Orthopedics of Russia. 2018;24(3):125. doi: 10.21823/2311-2905-2018-24-3-125-134
  8. Solovev DO, Maslova IL, Surkova PV, Maslov LB, Zhmaylo MA, Kovalenko AN. Comparative analysis of the revision acetabular customized implant position by finite element modeling. IOP Conference Series: Materials Science and Engineering. 2020;747:012076. doi: 10.1088/1757-899X/747/1/012076
  9. Korytkin AA, Novikova YS, Kovaldov KA, Korolev SB, Zykin AA, Gerasimov SA, et al. Mid-Term Outcomes of Revision Hip Arthroplasty with Acetabular Augments. Traumatology and Orthopedics of Russia. 2019;25(1):9. doi: 10.21823/2311-2905-2019-25-1-9-18

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies